PhilHealth Coverage vs. The 20% Senior Discount: A Key Distinction
It's important to understand that the benefits senior citizens receive from PhilHealth are separate from the 20% discount and VAT exemption provided by the Expanded Senior Citizens Act (RA 9994) [3]. PhilHealth functions as health insurance, while the 20% discount applies to out-of-pocket expenses for certain goods and services, including medical costs [3, 6].
The Universal Health Care (UHC) Act ensures that all Filipino citizens aged 60 and over are automatic PhilHealth members, with the government covering their premiums. This means they are entitled to various benefits regardless of their contribution history [1, 2].
How PhilHealth Benefits Work for Seniors
PhilHealth benefits for seniors are based on an All Case Rate (ACR) system, not a percentage discount. This system provides a pre-determined coverage amount for specific medical conditions, procedures, and cases. The actual benefit amount depends on the diagnosis [1].
Examples of benefits include:
- Inpatient Benefits: Covers a set amount for room and board, medications, lab tests, and professional fees during hospitalization for a specific illness [1].
- Outpatient Benefits: Includes coverage for procedures like hemodialysis, radiotherapy, and outpatient blood transfusions [1].
- Z-Benefit Packages: Offers support for expensive, catastrophic illnesses such as certain cancers [1].
- Konsulta Package: Focuses on preventive care, covering consultations, screenings, select lab tests, and medicines [1].
PhilHealth pays a fixed amount for a given case directly to the hospital. Any remaining balance is the patient's responsibility, and it is on this remaining amount that the 20% senior citizen discount and VAT exemption are applied [3, 6].
Eligibility and Availing Benefits
Eligibility is automatic for all Filipinos aged 60 and above [1, 2]. They can be enrolled at the healthcare facility if not previously registered [1].
To avail benefits:
- Inform the staff at a PhilHealth-accredited facility that the patient is a senior citizen [1].
- Present a valid government ID showing age (e.g., Senior Citizen's ID, Passport, UMID) for verification through the HCI Portal [1, 4].
- PhilHealth coverage is automatically deducted from the total bill upon successful verification [1].
- The 20% senior citizen discount and VAT exemption are then applied to the remaining balance [3, 6].
Comparing PhilHealth Coverage and the 20% Senior Citizen Discount
| Feature | PhilHealth Coverage | 20% Senior Citizen Discount (RA 9994) |
|---|---|---|
| Governing Law | Universal Health Care Act (RA 11223) & RA 10645 | Expanded Senior Citizens Act (RA 9994) |
| Nature of Benefit | Health insurance coverage based on fixed case rates. | A flat 20% discount plus VAT exemption. |
| How it Works | Fixed amount paid by PhilHealth, reducing the total bill. | Applied to the out-of-pocket portion of the bill. |
| When it's Applied | First deduction on the total hospital charges. | Second deduction, applied after PhilHealth coverage. |
Example: If a total bill is P50,000 and PhilHealth covers P22,000 (case rate), the remaining balance is P28,000. After deducting VAT exemption (e.g., P3,000), the balance is P25,000. The 20% senior discount (P5,000) is applied to this P25,000, resulting in a final amount payable of P20,000 [3, 6].
No Balance Billing Policy
Indigent senior citizens admitted to government or public hospitals may benefit from the No Balance Billing (NBB) policy, where PhilHealth covers the entire cost of services within their benefit package, resulting in no out-of-pocket expenses [1].
Conclusion
For senior citizens in the Philippines, understanding PhilHealth benefits means recognizing it as comprehensive insurance coverage based on case rates, not a simple percentage discount. Automatic membership through the Universal Health Care Act provides a crucial safety net for medical costs. Knowing that PhilHealth coverage is applied first, followed by the 20% senior discount, helps seniors and their families effectively manage healthcare expenses and utilize their rightful benefits. For detailed information on specific case rates, the official PhilHealth website is the best resource [1].
